The Effect of Adaptation Training on Controlling Maladaptation Behaviors in Adolescents with Asthma Based on Roy Adaptation Model.

Background
Asthma is a common long term inflammatory disease during adolescent. Absence of school education and reduction of mental and social mindedness are among the most common problems found in adolescents with asthma. Therefore, the present study was aimed to examine the effect of Roy adaptation model on controlling maladaptation behaviors in adolescents with asthma.


Materials and Methods
This study is a semi-experimental research that was conducted with the participation of all adolescents with asthma referred to the Asthma and Allergy Clinic of Shariati Hospital. Random sampling was used for a total of 64 adolescents to have two groups of intervention and control. Data collection was through a questionnaire based on the Roy's Adaptation Model. Over six weeks, adolescents were trained in six two-hour sessions. Data were analyzed by descriptive and analytical statistics consisting of Mann-Whitney, ANOVA, paired t-test and independent t-test.


Results
The mean age of adolescents with asthma in the intervention and control groups was 15.8±3.5 and 14.8±3.5 years, respectively. Also, the mean score of maladaptation behaviors in four physiological, self-concept, role-function and interdependence modes had a significant difference in intervention group before and after training (p<0.001), but there was no significant difference in all modes before and after intervention in control group (p>0.05).


Conclusion
Given the effect of Roy adaptation model on the different aspects of maladaptation behaviors in adolescents with asthma, it is recommended to use this model as a healthcare intervention for controlling maladaptation behaviors in adolescents with other chronic disease.


INTRODUCTION
Asthma is one of the most common chronic diseases among children and adolescents worldwide, and the foremost cause for inability in children (1). As shown, 1.6 million emergency visits, more than two million hospitalizations, and around 1.1 million days of school absence, main activity limitation, and disappointing performance in children are nearly due to asthma (2). It is reported that this disease is prevalent in 5-10% of children and adolescents worldwide. The prevalence of asthma in Iran is 2.7-35.4% in children, with the highest related mortality in adolescents of 11-17 years (3). Asthma in adolescence poses several challenges for adolescents and causes to add to the possibility of symptoms' exacerbation and asthma attacks due to occurrence of important physical, psychological, emotional, sexual, and social variations in adolescence (4).
Co-occurrence of disease complications such as treatment procedures, mental and physical stress, change in roles, interactions and communications in the changes and transformations of adolescence, may prevent an adolescent from having self-control (5). Although much progress has been made in the management of asthma in adolescents, but its complications is increasing (3). The inability to perform optimal ventilation restricts the level of tolerance to physical activity and this can affect social interactions, leading to social isolation of patient (6).
Generally, asthma affects not only the health of children and adolescents, but also has an impact on other aspects of life such as coping style, mental performance and overall quality of life. The results of study showed that asthma not only affects children and adolescents' physical status but also influences their social, emotional and educational status, since it can lead to school absenteeism, academic failure and the reduction of social and psychological adaptation. Therefore, considering adaptation decrease in physical, social and psychological aspects (7,8), and the failure of individual's effort to build effective adaptation, effective nursing care gains more importance as nurses play a major role in supporting patients with chronic diseases to have adaptation (9,10). These behaviors are typically disruptive and dysfunctional behaviors which can range from mild to severe in scope, determined in four modes with behavior stimuli, and subsequently the exact caring and educational programs will be designed to meet the maladaptive behaviors (11,13,14). In this connection, Whittemore study presented that Roy adaptation model which led to increased level of adaptation in self-concept and role-function modes in adolescents with diabetes (15). Furthermore, the study conducted by Afrasiabifar also displayed that Roy model is effective in increasing compliance of hemodialysis patients in two modes of self-concept and physiology (16).
Diagnosing and offering appropriate care solutions that lead to increased adolescents compliance with existing conditions gain importance due to the chronic nature of asthma and the fact that adolescents have long-term use of drugs, and also taking into account patients' care needs along with the issue that high energy, and power generation are regarded as social values.
Therefore this study was aimed to examine the effect of Roy adaptation model on controlling maladaptation behaviors in adolescents with asthma.  showed that there was no statistically significant difference between the two groups in terms of father and mother's occupation and their education level (p>0.05) (Table 1) .

MATERIALS AND METHODS
Also, the mean score of maladaptation behaviors in four physiological, self-concept, role-function and interdependence modes had a significant difference in intervention group before and after training (p<0.001). This means that the decline in mean scores of maladaptation behaviors after training was related to role-function mode and then interdependence mode. On the contrast, there was no significant difference in all modes before and after training in control group (p>0.05) (Tables 2, 3).  one's disease (19).
One study suggested that, coping mediates the effect of symptoms of asthma on quality of life among patients (20). supporting self-care behaviors and assisting to achieve the skills in order to adapt to chronic conditions of the disease (20).

Study limitations
The researcher held the sessions at the end of the week since the training sessions overlapped with school timing of the adolescents. This can be seen as the most considerable limitation of the study.